Expanding trial stem for orthopaedic surgery

ABSTRACT

A trial device and a method for using the device in surgery are disclosed. The device includes a body including a proximal portion and a distal portion. The proximal portion has a post or trunion projecting therefrom. The distal portion extends from the proximal portion and includes a first arm and a second arm, the first and second arms being movable with respect to one another. The body further includes a cavity formed therein so as to extend through the proximal portion and into the distal portion. The device further includes a driver adapted for sliding engagement within the internal cavity of the body such that movement of the driver, preferably in a distal direction, causes movement of a portion of the first arm away from a portion of the second arm.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 11/503,459, filed Aug. 11, 2006, the disclosure of which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

A joint replacement procedure is sometimes necessary to repair a jointhaving a diseased or damaged articulating surface. Such a procedureinvolves removal of the diseased or damaged portions of the joint andreplacing them with a prosthetic implant. This is often a desirableprocedure for ball-and-socket type joints, particularly the shoulder andhip joints. A shoulder joint replacement procedure, for example, ofteninvolves removal of the humeral head and replacement thereof with animplant including a stem and a head. It is important that the implant bepositioned correctly within the joint in order to ensure thatappropriate joint kinematics, including range of motion, are preservedso as to replicate, as closely as possible, those of the original joint.

The structure of prosthetic joint components has been developed to besuited for permanent implantation into the joint and includes featuresthat may promote bony ingrowth, adhesion using cement, press-fit or acombination thereof. Particularly, in the case of implants including astem, such as those used in shoulder arthroplasty, these features areincluded on the outside surface of the stem. Such features are notwell-suited for use during the assessment of joint kinematics.Accordingly, instruments to be used in this part of the procedure havebeen developed. For shoulder arthroplasty, two general types of suchdevices have been developed, both of which are affixed to the boneduring joint kinematic evaluation and removed therefrom after a properposition for the implant has been determined.

One such device is an externally-fixated jig. These devices, howevertend to be bulky, complex and time consuming to set up and use. Theyalso require the use of external fixation devices and/or power toolsthat introduce further complications to the surgical procedure. Becausethese devices exit through the incision to the outside of the body theyare generally cumbersome making accurate range of motion assessmentdifficult. Such jigs are shown in U.S. Pat. Nos. 6,267,785 and6,193,758.

An additional or alternative device is a trial. Typically, these devicesare designed to correspond to an implant in size and shape. The trial isdesigned to be temporarily inserted into a prepared medullary canal ofthe humerus in a manner similar to that of an implant. Known trials aretypically used in conjunction with a lap sponge that is temporarilywrapped around the distal portion of the trial. The sponge-wrapped trialis then wedged into the canal, the sponge promoting a pressure fittherebetween, to evaluate the appropriate position for the implant. Inthe alternative, a foam ring can be assembled onto the trial stem asdiscussed in the brochure entitled Zimmer Trabecular Metal™ Humeral StemFour-Part Fracture Surgical Technique, available from Zimmer, Inc., P.O.Box 708, 1800 West Center Street, Warsaw, Ind. 46581-0708. Whileeliminating the problems associated with externally-fixated devices,known trials present other problems. For example, by positioning aresilient material, such as a sponge, between the inside surface of theprepared medullary canal and the trial stem, the stem may be allowed tomove within the joint leading to an unreliable joint kinematicsassessment. Additionally, the use of a lap sponge to hold the trialwithin the medullary canal leads to a risk of leaving sponge or clothdebris behind in the bone after the trial is removed.

It is therefore necessary to provide a device that can be used forimproved assessment of joint kinematics during a joint arthroplastyprocedure conducted on a joint.

SUMMARY OF THE INVENTION

The present invention relates to a trial device for use in surgery. Thedevice includes a body including a proximal portion and a distalportion. The proximal portion has a post or trunion projectingtherefrom. The distal portion extends from the proximal portion andincludes a first arm and a second arm, the first and second arms beingmovable with respect to one another. The body further includes a cavityformed therein so as to extend through the proximal portion and into thedistal portion. The device further includes a driver adapted for slidingengagement within the internal cavity of the body such that movement ofthe driver, preferably in a distal direction, causes movement of aportion of the first arm away from a portion of the second arm.

In one embodiment the distal portion of the body includes an outerbone-engaging surface, which may be formed from a plurality ofintersecting grooves. In a preferred embodiment, a portion of the boneengaging surface extends along a portion of the first arm in an arcuatefashion between a first edge of the first face and a second edge of thefirst face, and a portion of the bone engaging surface extends along aportion of the second arm in an arcuate fashion between a first edge ofthe second face and a second edge of the second face. The portion of thebone engaging surface which extends along the first arm preferably formsa first apex opposite the first face extending substantially in aproximal-distal direction, and the portion of the bone engaging surfacewhich extends along the second arm preferably forms a second apexopposite the second face extending substantially in a proximal-distaldirection. Further preferably, the movement of the driver in a distaldirection causes movement of the first arm and second arm from a firstposition, in which the first apex and the second apex form an angletherebetween having an intersection spaced distally from the body, to asecond position, in which the first apex and the second apex aresubstantially parallel.

A further embodiment of the present invention relates to a method forperforming a joint replacement surgery. The method includes introducingthe trial device into a joint such that at least a portion of the trialextends into to a prepared bone canal associated with the joint. Thetrial is adapted to fit within the bone canal and has an expandable boneengaging surface and a feature which is operable to cause expansion ofthe bone engaging surface. The method further includes manipulating theimplant into a first position within the joint and temporarily securingthe implant within the joint by operating the feature of the implant soas to cause the bone engaging surface to expand and engage an interiorsurface of the prepared bone canal.

The trial provided in the method of the present embodiment may also besuch that the feature of the trial is further operable to reverse theexpansion caused of the trial. The method may include operating thefeature of the trial to reverse the expansion of the bone engagingsurface. The method may further include manipulating the trial into asecond position within the joint, and temporarily securing the trialwithin the joint by operating the feature of the trial so as to causethe bone engaging surface to re-engage the interior surface of theprepared bone canal. The trial associated with the method of the presentembodiment may further include a visual indicia relating to the positionof the trial within the joint. The method may, accordingly, include thestep of using the indicia to establish a location of the trial relativeto the joint.

The method further includes removing the trial implant from the jointand providing an implant corresponding in size to a size of the trialand includes indicia that correspond to the indicia of the trial. Theimplant is then introduced into the joint such that at least a portionof the implant extends into the prepared bone canal.

A further embodiment relates to a method for performing surgery. Themethod includes introducing a trial into a joint such that at least aportion of the trial extends into a prepared bone canal associated withthe joint, the trial being adapted to fit within the prepared bone canaland having a proximal portion and a distal portion. The distal portionincludes an expandable bone engaging surface formed over a first arm anda second arm, the first and second arms extending from the proximalportion of the trial. The trial further includes a cavity extendingthrough the proximal portion and into the distal portion and a driveradapted for sliding engagement within the internal cavity. The methodfurther includes manipulating the trial into a first position within theprepared bone canal and temporarily securing the trial within theprepared bone canal by moving the driver distally within the cavity soas to cause a portion of the first arm and a portion of the second armto move outwardly away from one another such that the expandable boneengaging surface engages an interior surface of the prepared bone canal.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be better understood on reading the followingdetailed description of nonlimiting embodiments thereof, and onexamining the accompanying drawings, in which:

FIG. 1 is a top view of a trial according to a embodiment of the presentdisclosure;

FIGS. 2 and 3 are elevation views of a trial according to an embodimentof the present disclosure;

FIG. 4 is a bottom view of a trial according to an embodiment of thepresent invention.

FIGS. 5 and 6 are elevation views of a trial according to an embodimentof the present invention, wherein a first plane lying on themedial-lateral and proximal-distal axes and a second plane lying on theanterior-posterior and proximal-distal axes intersect the trial;

FIG. 7 is a bottom view of the planes shown in FIGS. 5 and 6intersecting a trial according to an embodiment of the presentinvention.

FIG. 8 is an exploded cross-section view of a trial according to anembodiment of the present invention;

FIG. 9 is a cross-section view of a trial according to an embodiment ofthe present disclosure, wherein the trial is inserted in an openingformed in a proximal humerus;

FIG. 10 is a cross-section view of a trial as shown in FIG. 9, whereinthe distal portion of the trial is expanded to temporarily secure thetrial within the opening formed in the proximal humerus;

FIG. 11 is an isometric view of a trial according to an embodiment ofthe present invention in which the trial is inserted into an openingformed in a proximal humerus, the trial including indicia relating tothe position thereof with respect to the proximal humerus;

FIGS. 12 and 13 are elevation views of a trial according to anembodiment of the present invention;

FIG. 14 is a bottom view of the trial shown in FIGS. 12 and 13; and

FIG. 15 is an exploded elevation view of a trial according to anembodiment of the present invention.

DETAILED DESCRIPTION

Referring to the drawings, wherein like reference numerals representlike elements, there is shown in FIGS. 1-4, in accordance with oneembodiment of the present invention, a trial, designated generally byreference numeral 10. In describing preferred embodiments of trial 10,reference will be made to the directional nomenclature used indescribing the human body. It is noted that this nomenclature is usedonly for convenience and that it is not intended to be limiting withrespect to the scope or structure of the invention. When referring tospecific directions, the device is understood to be described only withrespect to its orientation and position during an exemplary applicationto the human body. As used herein when referring to bones or other partsof the body, the term “proximal” means close to the heart and the term“distal” means more distant from the heart. The term “inferior” meanstoward the feet and the term “superior” means toward the head. The term“anterior” means toward the front part or the face and the term“posterior” means toward the back of the body. The term “medial” meanstoward the midline of the body and the term “lateral” means away fromthe midline of the body.

It is further noted that, although the present invention is shown anddescribed with respect to a humeral trial, it is understood thatparticular aspects of the present invention can be applied to additionaldevices. Such devices generally include humeral implants and bothfemoral implants and femoral trials.

Returning now to FIGS. 1-4, an exemplary embodiment of trial 10 is shownas one which is adapted for insertion into the proximal portion of aprepared humerus and includes a proximal portion 12 and a distal portion14. Proximal portion includes post 13 which is structured to receive atrial humeral head (not shown) to be used during trialing of the jointusing trial 10. Distal portion 14 of trial 10 projects along alongitudinal axis thereof from proximal portion 12 generally in theproximal-distal direction. Distal portion 14 is structured to fit withina prepared bone canal, preferably the medullary canal of the humerus.Post 13 has a longitudinal axis 16 that is angled with respect to thelongitudinal axis 19 of distal portion 14 so as to substantiallyreplicate the typical geometry of the prepared bone.

Distal portion 14 includes a first arm 20 and a second arm 22 that arepositioned adjacent to each other. Arms 20, 22 each have a respectiveinwardly-directed face 24, 26, which is generally planar and lies alongthe anterior-posterior and proximal-distal directions. First and secondarms 20, 22 each further include a respective outside surface 28, 29which forms a substantially semi-circular cross-section (as shown inFIG. 4) along a plane normal to the longitudinal axis of distal portion14. First arm 20 and second arm 22 are designed to be movable withrespect to one another between a first position and a second position.The movement of first and second arms 20, 22 results in expansion of thedistal portion 14 whereby a point along the outside surface 28 of firstarm 20 moves away from a point along the outside surface 29 of secondarm 22 in a direction lying in a plane defined by the medial-lateral andanterior-posterior axes, i.e. parallel to the frontal plane. In analternative embodiment, first and second faces 24, 26 may be positionedso as to lie along medial-lateral and proximal-distal axes. In such anembodiment, the movement of first and second arms occurs along a planelying along an anterior-posterior axis and a proximal-distal axis.

In a preferred embodiment, when first and second arms 20, 22 are in thefirst position, first and second faces 24, 26 are generally parallel toeach other and are spaced apart from each other at a predetermineddistance. Preferably the distance between faces 24 and 26 is about0.055″ to 0.073″. Further preferably, when arms 20, 22 are in the secondposition, faces 24, 26 are angled with respect to one another. The angleformed by first and second faces 24, 26 preferably has an apex locatedproximally of distal portion 14 and has a value of between 0.5o and 2o.More preferably, the value of the angle formed between first and secondfaces 24, 26 is about 1o.

As shown in FIGS. 5-7, outside surfaces 28 and 29 are preferably taperedalong first plane 100 such that a point on outside surface 28 near thetip 17 of distal portion 14 intersects first plane 100 is spaced apartfrom second plane 102 at a distance dd, and a point on outside surface28 near proximal end 15 of distal portion 14 intersects first plane 100is spaced apart from second plane 102 by a distance dp. Preferably, ddis less than dp by an amount of between 1 mm and 0.25 mm. Morepreferably, dd is less than dp by a distance of about 0.5 mm.Preferably, outside surface 29 of second arm 22 is tapered so as tosubstantially match the taper of first arm 20. Preferably, distalportion is tapered along plane 102 by an amount less than that of thetaper along plane 100. Further, distal portion may not be tapered alongplane 102. The amount of the taper formed in outside surfaces 28, 29along additional planes (not shown) located between the first and secondplanes and extending through the longitudinal axis of distal portion 14vary such that those closer to the first plane 100 will have a greatertaper than those closer to the second plane 102 such that distal portion14 has an oblong cross-sectional shape near tip 17.

Furthermore, outside surfaces 28, 29 are preferably shaped such that,during expansion thereof, arms 20, 22 can be positioned relative to eachother such that outside surfaces 28, 29 together form a substantiallycylindrical shape. In such a position, dp is substantially equal to dd,each being substantially equal to the radius of a cylinder having acenter along the longitudinal axis of distal portion 14. Furthermore, inthis position, substantially all points lying along outside surfaces 28,29 of arms 20, 22 are spaced apart from the longitudinal axis of distalportion 14 at a distance equal to that of the radius of the cylinder. Inorder for distal portion to form such a shape while arms 20, 22 are inthe second position, it may be necessary to form outside surfaces 28, 29such they have a taper along plane 102.

The movement of first arm 20 and second arm 22 is preferably achieved bybending of first arm 20 and second arm 22 in their respective directionsof movement. In order to allow first and second arms 20, 22 to bend assuch, distal portion 14 of trial 10 is preferably designed to provideadequate strength to allow for trial 10 to be secured within the bonecanal during trialing, and should be somewhat flexible to allow arms 20,22 to move when a force is applied thereto. Further preferably, firstand second arms 20, 22 bend substantially only near proximal end 15 ofdistal portion 14 such that first and second faces 24, 26 remainsubstantially planar when first and second arms 20, 22 are in the secondposition. Such flexing of arms 20, 22 can be accomplished by formingdistal portion 14 such that the structure thereof is weaker in the areawhere bending is desired. The area of bending can, for example, beformed such that proximal end 15 of distal portion 14 is thinner indiameter than the remainder of distal portion 14. Further, the area ofbending can also include hole 21 at the point where arms 20, 22 extendfrom proximal portion 12. Hole 21 reduces the stress concentration atthis location within trial 10 and allows for repeated flexing of arms20, 22 with a reduced risk of formation of cracks which can propagateinto proximal portion 12 and cause breakage of trial 10. Hole 21 furtherprovides a more flexible point within the structure of trial 10 wherearms 20, 22 can bend.

In order to cause movement of arms 20, 22 a cavity (shown in FIGS.8-10), preferably in the form of hole 30 is formed within trial 10 alongthe longitudinal axis of distal portion 14. Hole 30 preferably extendsthrough proximal portion 12 of trial 10 and into distal portion 14. Theportion of hole that is formed in distal portion 14 of trial 10 extendspartially into first arm 20 and partially into second arm 22. Hole 30 isadapted to receive driver 32, which is preferably substantiallycylindrical in shape. Preferably, driver 32 includes a threaded portion31 and mates for threading engagement with a threaded portion 33included within proximal portion 12 of trial 10 such that turning driver32 with respect to hole 30 causes advancement and withdrawal of driver32 within hole 30. Driver 32 preferably further includes a head 34(shown in FIG. 8) adapted to be used in conjunction with an instrumentsuch as a hex wrench or a screwdriver.

As best shown in FIGS. 8 and 9, hole 30 includes a terminal end 36 whichis located within distal portion 14, and is preferably located near themidpoint thereof. Terminal end 36 of hole 30 is preferably generallyconical in shape so as to form a surface that is inclined from theinterior surface of hole 30 to the first and second faces 24, 26 offirst and second arms 20, 22. The distal end 35 of driver 32 ispreferably in the shape of a wedge, and is preferably conical so as tomatch the shape of terminal end 36 of hole 30 and being able to rotatewhile maintaining contact therewith. Alternatively, distal end 35 can berotatably affixed the remainder of driver 32 and can fit within terminalend 36 of hole 30 so as to operatively engage terminal end 36 withoutrotating with respect thereto. Such an arrangement may serve to preventwear of terminal end 36 which could be caused by rotating distal end 35therein. The preferred conical shape driver end 35 and the complementaryconical shape of terminal end 36 of hole 30 act together to effectmovement of first arm 20 and second arm 22 with respect to each other.This is done, for example, by turning driver 32 with respect to hole 30such that driver 32 moves distally within hole 30. The distal movementof driver 32 within hole 30 causes operative engagement of distal end 36of driver 32 with terminal end of hole 30 such that first arm 20 andsecond arm 22 are forced outward with respect to each other, as shown inFIG. 10.

As also shown in FIGS. 8-10, the portion of hole 30 that is formed inproximal portion 12 of trial 10 is shaped to conform to thecorresponding shape of driver 32. In particular, hole 30 changesdiameter at two chamfered portions 5, 6, one located above and onelocated below threaded portion 33. The chamfered portions 5, 6 of hole30 correspond to chamfered portions 3, 4 of driver 32, as shown in FIGS.9 and 10. In FIG. 9, trial 10 is illustrated with driver 32 not fullyadvanced within hole 30. In that position, the chamfered portions 3, 4of driver 32 are spaced from the corresponding chamfered portions 5, 6of hole 30, and the arms 20, 22 are not fully expanded against theinterior surface 204 of opening 202 in humerus 200. In FIG. 10, driver32 is advanced distally, causing the first and second arms 20, 22 tomove into the second position, in which substantially all of distalportion 14 of trial 10 contacts the interior surface 204 of opening 202.In that position, the chamfered portions 3, 4 of driver 32 contact thechamfered portions 5, 6 of hole 30. Due to the change in diameter ofhole 30 at chamfered portions 5, 6, driver 32 can not move distally anyfurther within hole 30 when the chamfered portions 3, 4 of driver 32contact the chamfered portions 5, 6 of hole 30. Thus, this contactlimits the expansion of arms 20, 22 beyond the second position, as shownin FIG. 10.

The structure of outside surfaces 28, 29 of arms 20, 22 may include aseries of intersecting groves 42, as shown in FIG. 2. This provides atexture to outside surfaces 28, 29 which creates friction between theinner surface of the prepared medullary canal and trial 10, when trial10 is inserted therein. By including grooves 42 in both theproximal-distal direction and longitudinally, around the circumferenceof outside surfaces 28, 29, friction is created in two directions, whichserves to secure trial 10 within the prepared medullary canal withrespect to rotational and axial movement thereof when trial 10 isinserted into the prepared medullary canal and secured therein throughexpansion of distal end 14.

An alternative embodiment of trial 310 is shown in FIGS. 12-14 andincludes a proximal portion 312 and a distal portion 314, the proximalportion having a post 313 extending therefrom along a longitudinal axis316. Distal portion 314 extends distally from proximal portion 312 alonga longitudinal axis 319 and includes a first arm 320, a second arm 321,and a third arm 322. Each arm 320, 321, and 322 includes a respectiveinwardly-directed face 324, 325, and 326. As shown in FIG. 14, a portionof each of faces 324, 325, and 326 is open to and spaced apart from atleast a portion of each of the remaining faces. For example, a portion324 a of face 324 is open to a corresponding portion of face 325 and aportion 324 b of face 324 is open to a corresponding portion of face326. Further preferably, portion 324 a of face 324 forms an angle ofapproximately 120 degrees with portion 324 b of face 324. Further eacharm 320, 321, and 322 includes a respective outside surface 327, 328,and 329.

Arms 320, 321, 322 are preferably shaped so as to be movable from afirst position to a second position by moving driver 332 within hole(not shown) in the distal direction. Preferably, distal portion 314 isshaped so that when arms 320, 321, 322 are in first position outsidesurfaces 327, 328, 329 are have a tapered shape similar to that of arms20 and 22 of trial 10, as discussed with respect to FIGS. 5-7. Furtherpreferably, distal portion 314 is shaped that when arms 320, 321, 322are in the second position, outside surfaces 327, 328, 329 form asubstantially cylindrical shape.

An additional alternative embodiment of trial 410 according to thepresent invention is shown in FIG. 15. Trial 410 includes a proximalportion 412 and a distal portion 414 projecting therefrom. Distalportion includes a first arm 420 and a second arm 422, each arm 420, 422having a respective, inwardly-directed face 424, 426. Trial 410 alsoincludes a driver mechanism comprised of a bolt 432 a and a nut 432 bthat is assembled into cavity 430 that extends through proximal portion412 and distal portion 414. Driver mechanism is operable to causeoutward movement of arms 420, 422 with respect to each other from afirst position to a second position by turning bolt 432 a into nut 432 bsuch that nut 432 b is drawn into distal portion in a substantiallyproximal direction. The interior surface of cavity 430 is preferablyinclined inwardly moving proximally from tip 417 of distal portion 414so as to promote the movement of arms 420, 422 by proximal movement ofnut 432 b.

As discussed with respect to previous embodiments, outside surfaces 428,429 are preferably tapered when arms 420, 422 are in the first positionin a similar manner to that of arms 20, 22 as discussed with referenceto FIGS. 5-7. Further, outside surfaces 428, 430 are preferably shapedthat when arms 420, 422 are in the second position, outside surfaces428, 429 form a substantially cylindrical shape.

A further embodiment of the present disclosure relates to a method forperforming surgery using a trial 10 according to the embodimentsdiscussed with reference to FIGS. 1-10. The method can be used, forexample, during arthroplasty procedures involving a ball-and-socket typejoint, preferably of a human patient, such as the hip or the shoulder.In the present example, the method is used during replacement of thehumeral head with a prosthetic implant during shoulder arthroplasty.Generally, such a procedure involves gaining access to the shoulderjoint through a retracted incision and removing the damaged humeralhead. The proximal end of the humeral medullary canal is then shaped inorder to accept an implant according to know methods which may includeusing a hand reamer to remove bone material until anappropriately-shaped opening 202 is formed in the proximal humerus 200for receiving an implant. Typically, successive reamers of increasingsize are used in order to form an opening of the desired size.

Once opening 202 is formed for receiving an implant, trialing isconducted to determine the proper size and location for the implantprior to implantation thereof. According to the present example,trialing includes inserting trial 10 according to the embodimentsdiscussed with respect to FIGS. 1-10 (although any of the additionalembodiments discussed herein could be used) into opening 202 in proximalhumerus 200. Preferably, the particular trial 10 selected corresponds tothe size of opening 202. Accordingly, a kit with a number ofdifferently-sized trials 10 according to the embodiments discussed withrespect to FIGS. 1-10 may be provided. Further, these differently-sizedtrials 10 may correspond to the increasingly-sized reamers, or othersimilarly acceptable devices, used to form opening 202 in proximalhumerus 200. For example, the distal portion 14 of a trial 10 accordingto one embodiment can, for example, be of a size that substantiallymatches that of the largest of the successive reamers used to formopening 202 in proximal humerus 200 when first and second arms 20, 22are in the second position.

Trial 10 for use in the method according to the present embodimentshould be sized relative to opening 202 formed in proximal humerus 200such that trial 10 can be slid into opening 202 and be temporarilysecured into place by expanding distal portion 14 thereof, as discussedwith respect to FIGS. 9 and 10. Preferably, at least a point on each ofoutside surfaces 28, 29 near tip 17 of distal portion 14 is spaced apartfrom the interior surface 204 of opening 202. Furthermore trial 10 issized such that when first and second arms 20, 22 are in the firstposition, substantially all of each outside surface 28, 29 of arms 20,22 located near proximal end 15 thereof is in contact with the proximalend 205 of interior surface 204 of opening 202. This sizing of trial 10may help provide for accurate placement of trial 10 within humerus 200prior to temporarily securing trial 10 therein. In an alternativearrangement, trial 10 may be sized such that substantially all of distalportion 14 is spaced apart from distal end 206 of interior surface 204prior to expansion thereof.

Once trial 10 is inserted into humerus 200, it is visually inspected todetermine if the correct size has been selected. This is done bycomparing the size of the trial 10 to the size of opening 202. If thesize of trial 10 selected is determined to be incorrect, another size isselected and inspected according to similar criteria. Once the correctsize trial 10 has been selected, a trial head is assembled onto trial 10by press-fitting the trial head (not shown) onto post 13. The particulartrial head used can be selected by visual comparison to the resectedhumeral head. Trial 10 with the assembled head is then aligned withinthe joint so as to contact the articulating surface of the glenoid. Inorder to aid in rotational alignment of trial 10 within opening 202,proximal portion 12 may include a hole 11 formed transverselytherethrough so as to extend from the anterior side to the posteriorside thereof. Hole 11 is designed to be used in connection with aversion rod 9 that is sized so as to slideably engage hole 11 and toextend away from trial 10 such that it can be used to impart arotational force thereto. Preferably hole 13 includes a flat side 8 tomate with a flat side 7 formed on the version rod 9 so as to preventrotation therebetween.

Distal portion 14 of trial 10 is then expanded to bring at least a pointalong distal portion near tip 17 into contact with interior surface 204of opening 202. Preferably, distal portion 14 is tapered, as previouslydiscussed with reference to FIGS. 8 and 9, such that expansion thereofcauses substantially all of distal portion 14 to contact the interiorsurface 204 of opening 202. Such an arrangement at least somewhat evenlydistributes the pressure formed by the expanded distal portion 14 oftrial 10 on interior surface 204 of opening 202 formed in humerus 200.Uneven distribution of such pressure occurring, for example, near tip 17of distal portion 14 can be problematic as it can cause damage to thehumerus and can result in an insecure fit between distal portion 14 andopening 202, which can further lead to an unreliable assessment of theplacement of trial 10. Preferably, expansion of distal portion 14 iseffected by inserting a tool, preferably of the hex-wrench type, intohead 34 of driver 32 and using the tool to turn driver 32 with respectto hole 30 so as to cause driver 32 to move distally within hole 30. Asdiscussed with respect to FIGS. 9 and 10, trial 10 is preferablystructured such that the distal movement of driver 32 within hole 30causes first arm 20 and second arm 22 to move into the second positionthereof.

Preferably, the desired expansion of distal portion 14 is achieved byrotating driver 32 through an angle of no more than 360o. Morepreferably, the desired expansion of distal portion 14 is achieved byrotating driver 32 through an angle of approximately 450. The anglethrough which driver 32 must be rotated in order to secure trial 10within opening 202 will vary with the shape of distal portion 14,particularly the distance by which outside surfaces 28, 29 are tapered,as well as the angle of the wedge formed on the end 35 of driver 32 andthe matching angle of the inclined portion 36 of hole 32 and the pitchof the threaded sections 31, 33 of hole 30 and driver 32. The diameterof distal portion 14 of the selected trial 10 compared to the diameterof opening 202 may also affect the rotation of driver 32 necessary toachieve the desired expansion for distal portion 14.

Preferably, the taper formed in distal portion 14 should be such thatexpansion of less than 1 mm is necessary to secure trial 10 withinopening 202. For example, when distal portion 14 of trial 10, as shownin FIGS. 1-9, is expanded such that outside surfaces 28, 29 of arms 20,22 engage the interior surface 204 of opening 202, the distance betweenfirst face 24 and second face 26 increases by less than 1 mm at thepoints thereof nearest the tip 17 of distal portion 14. More preferably,the distance of expansion necessary for a point on distal portion 14near tip 17 to engage interior surface 204 is about 0.5 mm.

Once trial 10, with a trial head assembled thereto, is secured in aposition within opening 202, the position thereof is assessed for properjoint kinematics. This is conducted according to generally known methodsand includes moving the arm of the patient so as to cause movement ofthe trial head with respect to the articulating surface of the glenoid(or a prosthetic articulating surface, if one is used to replace thearticulating surface of the glenoid). If the position in which trial 10is temporarily secured is determined to be unsatisfactory for providingproper joint kinematics, trial can be loosened from within the preparedhumeral canal by withdrawing driver 32 within cavity 30. The position oftrial 10 within opening 202 can then be adjusted, and trial 10 can besecured in that position by expansion of distal portion 14 as discussedabove.

When a satisfactory position has been achieved for trial 10 withinopening 202, the humerus 200 is moved so as to withdraw the trial headfrom the articulating surface of the glenoid. The position of trial 10within opening 202 is then established. This is done using a series ofheight markings 60 and at least one version marking 62 (as shown inFIG. 1) included on proximal portion 12 of trial 10. Height 60 andversion 62 markings correspond to similar markings that may be includedon the implant that corresponds in size to trial 10. Height markings 60are used to measure the height of trial 10 within, for example, thehumerus 200 and are preferably used to measure the height of trial 10with respect to the upper edge 208 of humerus 200, which is formed bythe plane in which the proximal humerus has fractured. The correspondingmarkings on the implant are later used to position the implant atsubstantially the same height. Version marking 62 is then used toestablish the rotational position of trial 10 within humerus 200. Thismay be done by extending the line of version marking 62 onto the humerus200 forming line 210, which may be done, for example, using a laser.Line 210 is then used as a guide in making a matching line on thehumerus by, for example, electrocautery. The corresponding versionmarking on the implant is then aligned with line 210 formed on humerus200 to provide the proper rotational alignment of the implant.Additionally, proximal portion 12 of trial 10 can include features whichcorrespond to similar features included on the corresponding implant,which may include, for example a plurality of circular features 64corresponding to suture holes of an implant. These features 64 can beused to assure that the corresponding features of the implant areproperly positioned when the implant is inserted into opening 202. Forexample, circular features 64 can be used to assess the location ofsuture holes of a corresponding implant while positioning trial 10within opening 202 such that the suture holes included on the implantwill be positioned so as to properly stretch muscles affixed thereto.

When the position of trial 10 within humerus 200 is established, distalportion 14 of trial 10 is loosened from within opening 202 by returningfirst and second arms 20, 22 to the first position thereof, preferablyby inserting a tool into driver 32 and using the tool to cause proximalmovement of driver 32 within hole 30. Trial 10 is then removed from theproximal humerus 200. An implant corresponding in size to the trial isthen inserted into opening 202 formed in the proximal humerus 200. Forexample, an implant may correspond in size to a trial 10 used to assessjoint kinematics and establish a position for the implant by having astem that is similarly shaped with respect to distal portion 14 of trial10 but is smaller in cylindrical diameter. The smaller diameter of thestem of the implant in this example compensates for the cement mantleinterposed between the stem of the implant and the interior surface 204of opening 202. Preferably, the stem of the implant is about 2 mmsmaller in diameter than distal portion 14 of the corresponding trial10. The implant is then aligned, as discussed above, and is secured inplace using a bone cement composition. The procedure is then completedby reattaching the bone fragments and any muscles or tendons which weredetached during the operation and closing the wound site.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

1. A method for performing surgery, comprising: introducing a trial atleast partially into a prepared bone canal within a bone, the trialhaving an expandable bone engaging surface and a feature which isoperable to cause expansion of the bone engaging surface; manipulatingthe trial into a first position within the prepared bone canal; andtemporarily securing the trial within the prepared bone canal byoperating the feature of the trial so as to cause the bone engagingsurface to expand and engage an interior surface of the prepared bonecanal.
 2. The method of claim 1, wherein the prepared bone canal isproximate a joint between the bone and a second bone.
 3. The method ofclaim 2, further comprising: assembling a head onto a post projectingfrom a proximal portion of the trial, the head having a firstarticulating surface; positioning the head so as to substantially matewith a second articulating surface associated with the joint; andtesting the joint to determine if a proper position for the trial hasbeen achieved.
 4. The method of claim 1, further comprising reversingthe expansion of the bone engaging surface.
 5. The method of claim 4,wherein the feature of the trial is operable to reverse the expansion ofthe bone engaging surface.
 6. The method of claim 4, further comprising:manipulating the trial into a second position within the prepared bonecanal after the step of reversing the expansion of the bone engagingsurface; and, subsequently, temporarily securing the trial within theprepared bone canal by operating the feature of the trial so as to causethe bone engaging surface to re-engage the interior surface of theprepared bone canal.
 7. The method of claim 1, further comprising:removing the trial from the prepared bone canal; and introducing animplant at least partially into the prepared bone canal.
 8. The methodof claim 7, further comprising affixing the implant within the preparedbone canal.
 9. The method of claim 7, further comprising operating thefeature of the trial to reverse the expansion of the bone engagingsurface before the step of removing the trial from the prepared bonecanal.
 10. The method of claim 7, wherein the trial includes a visualindicia relating to the position of the trial within the prepared bonecanal, and wherein the method further comprises using the indicia toestablish a location of the trial relative to the bone.
 11. The methodof claim 10, wherein the implant includes an indicia that corresponds tothe indicia of the trial.
 12. The method of claim 10, further comprisingmanipulating the implant into a position that corresponds to the firstposition of the trial using the indicia of the implant.
 13. The methodof claim 12, wherein the visual indicia of the trial includes aplurality of markings on the proximal portion thereof, the markingsrelating to a position of the trial with respect to the prepared bonecanal in a proximal-distal direction.
 14. The method of claim 12,wherein the visual indicia of the trial includes a marking on theproximal portion thereof, the marking relating to a version position ofthe trial with respect to the prepared bone canal.
 15. The method ofclaim 1, wherein the trial includes a proximal portion having a holeextending transversely therethrough, the hole being adapted to receive arod, and wherein the step of manipulating the trial into a firstposition within the prepared bone canal includes applying a force to therod so as to rotate the trial within the prepared bone canal.
 16. Themethod of claim 1, wherein the trial includes a proximal portion and adistal portion, the distal portion of the trial including a first armand a second arm, the first and second arms extending from the proximalportion of the trial in a substantially proximal-distal direction,wherein the expandable bone engaging surface is formed on the first andsecond arms, and wherein the step of temporarily securing the trialwithin the prepared bone canal includes causing a portion of the firstarm and a portion of the second arm to move outwardly away from oneanother such that the bone engaging surface forms a substantiallycylindrical shape.
 17. The method of claim 16, wherein the trialincludes a cavity extending through the proximal portion and into thedistal portion and a driver adapted for sliding engagement with thecavity, and wherein the step of temporarily securing the trial withinthe prepared bone canal includes moving the driver distally within thecavity.
 18. The method of claim 17, wherein the driver includes athreaded portion near a proximal end thereof, wherein the proximalportion of the trial includes a threaded portion therein adapted tosubstantially mate with the threaded portion of the driver, and whereinthe step of moving the driver distally within the cavity includesrotating the driver with respect to the cavity.
 19. The method of claim16, wherein, prior to the step of temporarily securing the trial withinthe prepared bone canal, the bone engaging surface is tapered along aproximal-distal plane therethrough such that a tip portion of the boneengaging surface is spaced apart from the interior surface of theprepared bone canal and an upper portion of the bone engaging surfacesubstantially contacts the interior surface of the prepared bone canal,and wherein the step of temporarily securing the trial within theprepared bone canal includes causing a portion of the first arm and aportion of the second arm to move outwardly away from one another suchthat the tip portion of the bone engaging surface substantially contactsthe interior surface of the prepared bone canal.
 20. The method of claim1, wherein the bone engaging surface is on a distal portion of the trialextending along a longitudinal axis, and wherein a cross-section of thedistal portion perpendicular to the longitudinal axis substantiallydefines a circle when the bone engaging surface is in an expandedposition, the cross-section being non-circular when the bone engagingsurface is in an unexpanded position.